Asthma Clinical Trial
To identify the role of irritant exposure in adult-onset asthma by simultaneously using both clinical and case control methods in a community-based perspective study of asthma incidence.
BACKGROUND:
Asthma incidence is increasing, and in adults work-related exposures may be an important
factor-occupational asthma (OA) incidence increased 70 percent over the last decade
according to a recent registry based study. The true contribution of occupational exposures
to adult-onset asthma is unknown because the methods for measuring OA give conflicting
results. Methods based on surveillance of clinically diagnosed OA account for less than one
to five percent of adult-onset asthma. However, case-control methods of measuring asthma
risk by industry suggest that six to 33 percent of adult-onset asthma is caused by workplace
exposures. The conflict may occur because of two factors: physicians often fail to diagnose
and report OA, and irritant exposures may increase the risk the risk of asthma without
causing cases that meet the clinical definition. Both factors have important implications
for proper treatment and prevention of asthma in adults.
DESIGN NARRATIVE:
Clinical and case control methods were used to identify the role of irritant exposure in
adult-onset asthma in a community-based prospective study of asthma incidence. The study
cohort was a typical US working population enrolled in an HMO. Additional benefits of the
study design were the opportunities to validate a questionnaire for exposure assessment and
for detection of work-related asthma. Specifically, the study: 1) Investigated incident
cases in a cohort of over 80,000 adults over three years and determined the proportion that
met a clinical definition of occupational asthma (OA); 2) Used a nested case-control study
to determine the incidence of all asthma by occupation and workplace exposure; 3) Determined
whether clinical OA accounted for the excess incidence of adult-onset asthma associated with
workplace exposure to sensitizers and irritants; 4) Prospectively followed asthmatics for
two years after diagnosis to determine the impact of adult-onset asthma on lung function,
employment, income, and quality of life, and to determine whether prognosis differed for
clinical OA and for asthma associated with workplace irritant exposure; 5) Tested an
intervention designed to increase appropriate clinical diagnosis, and thus secondary
prevention of OA.
The study completion date listed in this record was obtained from the "End Date" entered in
the Protocol Registration and Results System (PRS) record.
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N/A
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